{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:40:38Z","timestamp":1784616038880,"version":"3.55.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016669","name":"Sj\u00f6bergstiftelsen","doi-asserted-by":"publisher","award":["20210114:6"],"award-info":[{"award-number":["20210114:6"]}],"id":[{"id":"10.13039\/100016669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Thirst and dry mouth are common symptoms among patients at the end of life. In palliative care today, there is a focus on mouth care to alleviate thirst. There are no qualitative studies on thirst from a physician\u2019s experience, which is why this study is needed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>This study aimed to explore palliative care physicians\u2019 experiences and views of thirst in patients at the end of life.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A qualitative interview study with an inductive approach was carried out. Sixteen physicians working in specialised palliative care units in Sweden were included. The interviews were analysed with a reflexive thematic analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The analysis resulted in three basic assumptions regarding thirst: It is dry mouth, not thirst; patients are dry in their mouth and thirsty; and, I do not know if they are thirsty. Further, four different themes regarding how to relieve thirst appeared: drips will not help thirst but cause harm; the body takes care of thirst itself; drips might help thirst; and, mouth care to relieve thirst or dry mouth.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The palliative care physicians had different experiences regarding thirst, from thirst never arising, to a lack of awareness. They thought good mouth care worked well to alleviate the feeling of thirst and dry mouth. Most physicians did not want to give patients drips, while some did. This study indicates that there are many unanswered questions when it comes to thirst at end-of-life and that further research is needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0290075","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T17:42:02Z","timestamp":1692207722000},"page":"e0290075","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Thirst or dry mouth in dying patients?\u2014A qualitative study of palliative care physicians\u2019 experiences"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9606-3238","authenticated-orcid":true,"given":"Maria","family":"Friedrichsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Lythell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiny","family":"Jaarsma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier","family":"Jaarsma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"\u00c5ngstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha","family":"Milovanovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit","family":"Karlsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-0702","authenticated-orcid":true,"given":"Anna","family":"Milberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3785-5630","authenticated-orcid":true,"given":"Hans","family":"Thulesius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4183-7598","authenticated-orcid":true,"given":"Christel","family":"Hedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana","family":"Waldr\u00e9us","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0380-3365","authenticated-orcid":true,"given":"Anne","family":"S\u00f6derlund Schaller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,16]]},"reference":[{"issue":"4","key":"pone.0290075.ref001","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0899-5885(18)30440-4","article-title":"Regulation of plasma osmolality: thirst and vasopressin","volume":"6","author":"K. Toto","year":"1994","journal-title":"Crit Care Nurs Clin North Am"},{"issue":"8","key":"pone.0290075.ref002","doi-asserted-by":"crossref","first-page":"300060520936069","DOI":"10.1177\/0300060520936069","article-title":"Family physicians\u2019 perspective on voluntary stopping of eating and drinking: a cross-sectional study","volume":"48","author":"S St\u00e4ngle","year":"2020","journal-title":"The Journal of International Medical Research"},{"issue":"2","key":"pone.0290075.ref003","doi-asserted-by":"crossref","first-page":"74","DOI":"10.12968\/ijpn.2017.23.2.74","article-title":"Declining oral intake towards the end of life: how to talk about it? A qualitative study","volume":"23","author":"J Clark","year":"2017","journal-title":"International Journal of Palliative Nursing"},{"issue":"5","key":"pone.0290075.ref004","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1370\/afm.1814","article-title":"Primary care patients hastening death by voluntarily stopping eating and drinking","volume":"13","author":"E Bolt","year":"2015","journal-title":"Ann Fam Med"},{"issue":"7","key":"pone.0290075.ref005","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/0885-3924(93)90188-2","article-title":"Dehydration symptoms of palliative care cancer patients","volume":"8","author":"F. Burge","year":"1993","journal-title":"J Pain Symptom Manage"},{"issue":"3","key":"pone.0290075.ref006","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/0885-3924(94)00123-3","article-title":"Dehydration and the dying patient","volume":"10","author":"J Ellershaw","year":"1995","journal-title":"J Pain Symptom Manage"},{"issue":"3","key":"pone.0290075.ref007","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s005200000205","article-title":"Determinants of the sensation of thirst in terminally ill cancer patients","volume":"9","author":"T Morita","year":"2001","journal-title":"Support Care Cancer"},{"issue":"3","key":"pone.0290075.ref008","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1136\/bmjspcare-2018-001729","article-title":"Hydration and symptoms in the last days of life","volume":"11","author":"M Lokker","year":"2021","journal-title":"BMJ Support Palliat Care"},{"issue":"3","key":"pone.0290075.ref009","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jpainsymman.2013.10.022","article-title":"Relationship between symptom burden, distress, and sense of dignity in terminally ill cancer patients","volume":"48","author":"K Oechsle","year":"2014","journal-title":"Journal of Pain & Symptom Management"},{"key":"pone.0290075.ref010","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1089\/jpm.2018.0020","article-title":"Use of Artificial Hydration at the End of Life: A Survey of Australian and New Zealand Palliative Medicine Doctors","volume":"21","author":"J Oehme","year":"2018","journal-title":"J Palliat Med"},{"issue":"3","key":"pone.0290075.ref011","doi-asserted-by":"crossref","first-page":"145","DOI":"10.12968\/ijpn.2008.14.3.28895","article-title":"Palliative care professionals\u2019 perceptions of nutrition and hydration at the end of life","volume":"14","author":"P van der Riet","year":"2008","journal-title":"International Journal of Palliative Nursing"},{"key":"pone.0290075.ref012","article-title":"One size fits all? What counts as quality practice in (reflexive) thematic analysis?","author":"V Braun","year":"2020","journal-title":"Qual Res Psychol"},{"issue":"4","key":"pone.0290075.ref013","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"V Braun","year":"2019","journal-title":"Qual Res Sport Exerc Health"},{"key":"pone.0290075.ref014","volume-title":"Successful qualitative research: A practical guide for beginners","author":"V Braun","year":"2013"},{"issue":"3","key":"pone.0290075.ref015","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.clnu.2016.02.006","article-title":"ESPEN guideline on ethical aspects of artificial nutrition and hydration","volume":"35","author":"C Druml","year":"2016","journal-title":"Clin Nutr"},{"issue":"9","key":"pone.0290075.ref016","doi-asserted-by":"crossref","first-page":"e0162261","DOI":"10.1371\/journal.pone.0162261","article-title":"Oral Cooling and Carbonation Increase the Perception of Drinking and Thirst Quenching in Thirsty Adults","volume":"11","author":"C Peyrot des Gachons","year":"2016","journal-title":"PLoS ONE"},{"key":"pone.0290075.ref017","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.appet.2013.09.011","article-title":"Cold pleasure. Why we like ice drinks, ice-lollies and ice cream","volume":"71","author":"R Eccles","year":"2013","journal-title":"Appetite"},{"key":"pone.0290075.ref018","unstructured":"NICE guidelines. Care of dying adults in the last days of life. National Clinical Guideline Centre. 2015(2022\u20130525) https:\/\/www.nice.org.uk\/guidance\/ng31\/chapter\/Recommendations#maintaining-hydration."},{"key":"pone.0290075.ref019","unstructured":"Royal Colleges of Nursing. Mouth Care Matters in End-of-Life Care. CLINICAL PROFESSIONAL RESOURCE. 2021;20220525. https:\/\/www.rcn.org.uk\/professional-development\/publications\/mouth-care-matters-in-end-of-life-care-uk-pub-009-921"},{"key":"pone.0290075.ref020","unstructured":"Scottish Palliative Care Guidelines. Care in the Last Days of Life. Mouth care. 2020. https:\/\/www.palliativecareguidelines.scot.nhs.uk\/guidelines\/symptom-control\/mouth-care.aspx"},{"issue":"16","key":"pone.0290075.ref021","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1001\/jama.1994.03520160047041","article-title":"Comfort care for terminally ill patients. The appropriate use of nutrition and hydration","volume":"272","author":"R McCann","year":"1994","journal-title":"JAMA"},{"key":"pone.0290075.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-684X-13-1","article-title":"Voluntary stopping of eating and drinking at the end of life\u2014a \u2019systematic search and review\u2019 giving insight into an option of hastening death in capacitated adults at the end of life","volume":"13","author":"N Ivanovi\u0107","year":"2014","journal-title":"BMC Palliat Care"},{"key":"pone.0290075.ref023","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1136\/bmjspcare-2020-002600","article-title":"What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis","volume":"11","author":"A Kingdon","year":"2021","journal-title":"BMJ Support & Palliat Care"},{"issue":"4","key":"pone.0290075.ref024","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/082585979501100404","article-title":"The sensation of thirst in dying patients receiving i.v. hydration","volume":"11","author":"C Musgrave","year":"1995","journal-title":"J Palliat Care"},{"key":"pone.0290075.ref025","first-page":"8","article-title":"Hypodermoclysis for control of dehydration in terminal-stage cancer","volume":"6","author":"L Cerchietti","year":"2013","journal-title":"International Journal of Palliative Nursing"},{"issue":"9","key":"pone.0290075.ref026","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1089\/jpm.2013.0557","article-title":"The volume of hydration in terminally ill cancer patients with hydration-related symptoms: a prospective study","volume":"17","author":"N Nakajima","year":"2014","journal-title":"J Palliat Med"},{"issue":"1","key":"pone.0290075.ref027","first-page":"1","article-title":"To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients","volume":"20","author":"C-Y Wu","year":"2021","journal-title":"BMC Palliative Care"},{"issue":"1","key":"pone.0290075.ref028","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1200\/JCO.2012.44.6518","article-title":"Roosth Jea. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial","volume":"31","author":"E Bruera","year":"2013","journal-title":"J Clin Oncol"},{"issue":"6","key":"pone.0290075.ref029","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/104990919401100607","article-title":"The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients","volume":"11","author":"A Waller","year":"1994","journal-title":"Am J Hosp Palliat Care"},{"issue":"4","key":"pone.0290075.ref030","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1089\/109662103768253669","article-title":"Agitated terminal delirium and association with partial opioid substitution and hydration","volume":"6","author":"T Morita","year":"2003","journal-title":"J Palliat Med"},{"issue":"3","key":"pone.0290075.ref031","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/bmjspcare-2013-000562","article-title":"What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature","volume":"5","author":"M Gent","year":"2015","journal-title":"BMJ Support Palliat Care"},{"key":"pone.0290075.ref032","volume-title":"Essentials of nursing research: methods, appraisal, and utilization","author":"DF Polit","year":"2006"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0290075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T17:42:31Z","timestamp":1692207751000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0290075"}},"subtitle":[],"editor":[{"given":"Taofiki Ajao","family":"Sunmonu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,8,16]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0290075","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,16]]}}}